MEDICARE: TORY LYNN WHITE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	NLC0013974	CO

General Provider Information

NPI Number	:	1467855585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TORY LYNN WHITE

Provider Business Mailing Address
First Line	:	5265 N ACADEMY BLVD
Second Line	:	SUITE 3300
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-4060
Country	:	US
Telephone Number	:	719-466-6772
Fax Number	:	719-599-7004

Provider Business Practice Location Address
First Line	:	5265 N ACADEMY BLVD
Second Line	:	SUITE 3300
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-4060
Country	:	US
Telephone Number	:	719-466-6772
Fax Number	:	719-599-7004

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2014
Last Update Date	:	10/03/2014

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